Universal Newborn Hearing Screening Program Research Articles

Coalition for Global Hearing Health Hearing Care Pathways Working Group: Guidelines for Clinical Guidance for Readiness and Development of Evidence-Based Early Hearing Detection and Intervention Programs.

Editor's Note: The following article discusses the timely topic Clinical Guidance in the areas of Evidence-Based Early Hearing Detection and Intervention Programs. This article aims to discuss areas of services needed, guidance to countries/organizations attempting to initiate early hearing detection and intervention systems. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. In Ear and Hearing, our long-term goal for the Point of View article is to stimulate the field's interest in and to enhance the appreciation of the author's area of expertise. Hearing is an important sense for children to develop cognitive, speech, language, and psychosocial skills. The goal of universal newborn hearing screening is to enable the detection of hearing loss in infants so that timely health and educational/therapeutic intervention can be provided as early as possible to improve outcomes. While many countries have implemented universal newborn hearing screening programs, many others are yet to start. As hearing screening is only the first step to identify children with hearing loss, many follow-up services are needed to help them thrive. However, not all of these services are universally available, even in high-income countries. The purposes of this article are (1) to discuss the areas of services needed in an integrated care system to support children with hearing loss and their families; (2) to provide guidance to countries/organizations attempting to initiate early hearing detection and intervention systems with the goal of meeting measurable benchmarks to assure quality; and (3) to help established programs expand and improve their services to support children with hearing loss to develop their full potential. Multiple databases were interrogated including PubMed, Medline (OVIDSP), Cochrane library, Google Scholar, Web of Science and One Search, ERIC, PsychInfo. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. Eight essential areas were identified to be central to the integrated care: (1) hearing screening, (2) audiologic diagnosis and management, (3) amplification, (4) medical evaluation and management, (5) early intervention services, (6) family-to-family support, (7) D/deaf/hard of hearing leadership, and (8) data management. Checklists are provided to support the assessment of a country/organization's readiness and development in each area as well as to suggest alternative strategies for situations with limited resources. A three-tiered system (i.e., Basic, Intermediate, and Advanced) is proposed to help countries/organizations at all resource levels assess their readiness to provide the needed services and to improve their integrated care system. Future directions and policy implications are also discussed.

Towards Comprehensive Newborn Hearing and Genetic Screening in Russia: Perspectives of Implementation

The universal newborn hearing screening (NHS) program was implemented in Russia in 2008 to replace the high-risk newborn hearing screening. More than 95% coverage and significant improvement in early detection and intervention is achieved. Meanwhile, it was shown that current OAE-based hearing screening missed 13% of newborns with genetically ascertained hereditary sensorineural hearing loss (SNHL). The aim of the study is to assess the results of genetic investigation and NHS in a large cohort of Russian children with bilateral SNHL and to study the feasibility of implementation of combined hearing and genetic screening in Russia. Genetic, audiological and NHS data of 1292 pediatric patients with bilateral SNHL born in 2008–2021 were analyzed. GJB2 sequencing was performed for all subjects, 644 patients had pathological GJB2 genotype, 406 of them were homozygous for c.35delG variant. The group of 155 GJB2-negative patients were searched for other SNHL genes, The pathological genotypes were identified at 87 patients. The most frequent genes were STRC (21.8%), USH2A (16.1%), OTOF (8%) and SLC26A4 (6.9%). Children with confirmed genetic etiology passed NHS in 21% of cases. The perspectives of implementation of national comprehensive newborn hearing and genetic screening including whole exome sequencing technologies are discussed.

Newborn and infant hearing screening for early detection of hearing loss in Nairobi, Kenya.

Early detection of hearing loss and subsequent intervention leads to better speech, language and educational outcomes giving way to improved social economic prospects in adult life. This can be achieved through establishing newborn and infant hearing screening programs. To determine the prevalence of hearing loss in newborns and infants in Nairobi, Kenya. A cross-sectional pilot study was conducted at the National hospital and at a sub county hospital immunization clinic. A total of 9,963 babies aged 0-3 years, were enrolled in the hearing screening program through convenient sampling over a period of nine months. A case history was administered followed by Distortion Product Oto-acoustic emissions (DPOAEs) and automated auditory brainstem response (AABR) hearing screening. The screening coverage rate was 98.6% (9963/10,104). The referral rate for the initial screen was 3.6% (356/ 9,963), the return rate for follow-up rescreening was 72% (258 babies out of 356) with a lost to follow-up rate of 28% (98/356). The referral rate of the second screen was 10% (26/258). All the 26 babies referred from the second screen returned for diagnostic hearing evaluation and were confirmed with hearing loss, yielding a prevalence of 3/1000. Establishing universal newborn and infant hearing screening programs is essential for early detection and intervention for hearing loss. Data management and efficient follow-up systems are an integral part of achieving diagnostic confirmation of hearing loss and early intervention.

Family-Perceived Barriers and Facilitators Toward a Tele-Audiology Infant Diagnostic Testing Approach in Victoria, Australia.

Background: Universal newborn hearing screening programs allow for early identification of congenital hearing loss. However, some families experience difficulties accessing diagnostic audiology services following a refer screen result. Methods: This study aimed to assess the opinions of families who had experienced infant diagnostic audiology assessments regarding a telehealth option for these appointments within Victoria, Australia. Families who attended in-person infant diagnostic audiology appointments were sent a questionnaire exploring their experiences of the service and their opinion regarding a proposed telehealth option for infant diagnostic audiology (50 responses received). These results were also compared to those of families who were surveyed following testing in 2020, where the audiologist conducted the appointment remotely to comply with COVID-19-related social distancing recommendations at the time (10 responses received). Results: There were not significant differences between the duration or number of appointments, perceived understanding of results, or concerns regarding a tele-audiology model between families who experienced face-to-face and tele-audiology infant diagnostic audiology appointments. Opinions of infant diagnostic audiology appointments utilizing telehealth technology were largely positive, and minimal technological difficulties were identified. Conclusion: Overall positive attitudes of many families with infant diagnostic appointment experiences toward a tele-audiology option of this service suggest that offering a telehealth model of appointments may be an appropriate model to improve service access for families requiring infant diagnostic audiology in Victoria.

SWOT analysis of Russian universal newborn hearing screening program

Introduction. The negative impact of congenital hearing loss on child’s development, education and socialization can be reduced by early identification and intervention as a result of universal newborn hearing screening. The screening program needs continuous improvement by monitoring of outcomes and correction of algorithms. The SWOT analysis can be applied to make effective decisions. 
 The purpose of the study is to identify strategies for the improvement of the Russian newborn hearing screening program based on SWOT analysis.
 Materials and methods. The study was based on the experience of two pediatric audiological centres in Novosibirsk and St. Petersburg. 
 At the first stage, in accordance with the SWOT methodology, internal and external factors, the strengths and weaknesses of the Russian hearing screening program were identified, as well as the opportunities and threats that can affect the audiological care for children. At the second stage, pairwise analysis of strengths, weaknesses, opportunities and threats was carried out.
 Results. The strengths of the Russian hearing screening program are national level implementation, high coverage of newborns in maternity hospitals, the use of modern objective audiological methods. Weaknesses are associated with a lack of medical personnel, need to equipment replacement, number of cases lost to follow-up. Opportunities are the availability of high-quality domestic diagnostic equipment, possibility for active interaction of specialists and families. The threats are caused by an imperfect legal framework and funding mechanisms, low awareness of parents, related professionals and society about the problem of congenital hearing loss. 
 Limitations. The study results are limited by the expertise of the authors without involving the wide range of stakeholders.
 Conclusion. The developed strategies can increase timely audiological service to hearing impaired children and their families and to plan the necessary resources in the face of modern challenges.

Newborn and Infant Hearing Screening for Early Detection of Hearing Loss in Nairobi, Kenya

Background: Early detection of hearing loss and subsequent intervention leads to better speech, language and educational outcomes giving way to improved socioeconomic prospects in adult life. This can be achieved through establishing universal newborn hearing screening (UNHS) programs. The objectives of this study were to assess the feasibility of implementing a UNHS program and to also determine the prevalence of hearing loss in newborns in Nairobi, Kenya.
 Materials And Methods: A cross-sectional pilot study was conducted at the National Hospital and a sub-county hospital immunization clinic. A total of 9,963 babies aged 0-3 years, were enrolled in the hearing screening program through convenient sampling over nine months. A case history was administered followed by Distortion Product Oto-acoustic emissions (DPOAEs) and automated auditory brainstem response (AABR) hearing screening.
 Results: The screening coverage rate was 98.6% (9963/10,104). The referral rate for the initial screen was 3.6% (356/ 9,963), and the return rate for follow-up rescreening was 72% (258 babies out of 356) with a loss to follow-up rate of 28% (98/356). The referral rate of the second screen was 10% (26/258). All 26 babies referred from the second screen returned for diagnostic hearing evaluation and were confirmed to have hearing loss, yielding a prevalence of 3/1000.
 Conclusions: Establishing universal newborn and infant hearing screening programs in Kenya is feasible and essential for early detection and intervention for hearing loss. Data management and efficient follow-up systems are an integral part of achieving diagnostic confirmation of hearing loss and early intervention.

Universal newborn hearing screening program in Saudi Arabia: Current insight

Newborn hearing screening (NHS) programs are essential to identify hearing loss early in life and to improve outcomes in children. In Saudi Arabia, the national NHS program has been operational since 2016; however, few studies have evaluated its status, and none have covered all provinces across the country. This cross-sectional retrospective study provides an overview of the program's status across all provinces, focusing on screening coverage rates, referral/fail rates, and follow-up procedures. In 2021, 199,034 newborns were screened, with a coverage rate of 92.6% and an overall referral/fail rate of 1.87%. These performance measures provide a foundation for future progress and improvements. This study highlights the importance of ongoing efforts to enhance the program's effectiveness and sustainability.

Analysis of audiological outcomes of children referred from a universal newborn hearing screening program over 9 years in Beijing, China

Universal newborn hearing screening (UNHS) and audiological diagnosis are crucial for children with congenital hearing loss (HL). The objective of this study was to analyze hearing screening techniques, audiological outcomes and risk factors among children referred from a UNHS program in Beijing. A retrospective analysis was performed in children who were referred to our hospital after failing UNHS during a 9-year period. A series of audiological diagnostic tests were administered to each case, to confirm and determine the type and degree of HL. Risk factors for HL were collected. Of 1839 cases, 53.0% were referred after only transient evoked otoacoustic emission (TEOAE) testing, 46.1% were screened by a combination of TEOAE and automatic auditory brainstem response (AABR) testing, and 1.0% were referred after only AABR testing. HL was confirmed in 55.7% of cases. Ears with screening results that led to referral experienced a more severe degree of HL than those with results that passed. Risk factors for HL were identified in 113 (6.1%) cases. The main risk factors included craniofacial anomalies (2.7%), length of stay in the neonatal intensive care unit longer than 5 days (2.4%) and birth weight less than 1500 g (0.8%). The statistical data showed that age (P < 0.001) and risk factors, including craniofacial anomalies (P < 0.001) and low birth weight (P = 0.048), were associated with the presence of HL. This study suggested that hearing screening plays an important role in the early detection of HL and that children with risk factors should be closely monitored.

Newborn Hearing Screening in Québec, Canada.

This study discusses the history and current state of the newborn hearing screening program in Québec and aims to assess general challenges associated with establishing universal newborn hearing screening (UNHS) programs. We reviewed the statistics of the occurrence and long-term effects of congenital hearing loss and the immediate and long-term benefits of UNHS and its limitations. The resources for this study included financial reports related to establishing UNHS in different health care systems; Canadian provincial, territorial, and federal regulations and publications; local and nationwide media; and interviews health care staff and program managers. Because of its benefits and its cost-effectiveness, UNHS programs have been implemented in many health care systems around the world. Despite Canada's success in offering a wide array of health care services to its citizens, certain provinces trail behind others in developing UNHS programs. Although there have been recent improvements in the screening rate of the province of Québec, nearly half of all Québec newborns continue to not be screened for hearing loss. The reasons for the current low screening rate include delays in implementation, information-technology complications, operating costs, and lack of public awareness. For UNHS to be implemented in a timely fashion, those involved in the process should first understand what challenges may arise. Québec's experience with this process may provide useful lessons for other health care systems.

Help-seeking behaviour of parents of children with hearing loss in India: a qualitative analysis

Objective The age of identification of hearing loss in children is highly influenced by the hearing help seeking behaviour of their parents, particularly in countries without universal newborn hearing screening programs. In this study, an attempt was made to identify the factors associated with help seeking behaviour in parents of children with hearing loss, and the relationship of such factors with the age of identification of hearing loss. Design Focus group discussions based on the framework of health belief model were carried out. The discussions were transcribed and the transcripts were thematically analysed. Study sample Participants were 35 parents of children with hearing loss from the state of Karnataka in India. Results The findings revealed 30 factors related to their awareness about hearing loss, geographical location, socio-economic status, family, and society. The factors differed between early and late help seekers. Conclusions Awareness, accessibility, and affordability are the key factors that influenced the hearing help seeking behaviour of the participants. Effective public awareness programs, newborn hearing screening programs, and provisions to make hearing healthcare affordable to all can reduce the age of identification of paediatric hearing loss in India.

Universal Newborn Hearing Screening Program: 10-Year Outcome and Follow-Up from a Screening Center in Germany.

Regular reporting of quality control is important in newborn hearing screening, ensuring early diagnosis and intervention. This study reports on a population-based newborn hearing screening program in North-Rhine, Germany and a hospital-based screening at a University Hospital for 2007-2016. The two-staged 'screening' and 'follow-up' program involving TEOAE and AABR recruited newborns through participating birth facilities. Results were sent to the regional tracking center, and the data were analyzed based on recommended benchmarks. The percentage of newborns from the participating birth facilities in the region increased from 1.4% in 2007 to 57.5% in 2016. The 10-year coverage rate for these newborns was 98.7%, the referral rate after a failed two-step screening was 3.4%, and the lost-to-follow-up rate was 1%. At the hospital, >95% of the screened newborns completed screening within 30 days, the 10-year referral rate was 5%, and 64% were referred within 3 months of age. The median time for screening completion was 6 days after birth, for referral it was 74 days after birth, and for diagnosis it was 55 days after birth. Regional-centralized tracking centers with uniform structure are necessary for proper quality control. Obligatory participation of birthing facilities and quality reports may improve performance, but the recommended quality criteria need considerable financial and infrastructural expenditure.

Does newborn hearing screening cause anxiety among mothers? A cross-sectional study from a tertiary hospital in Malaysia

BackgroundThe universal newborn hearing screening (UNHS) has effectively allowed babies with hearing loss to be detected early. However, findings from previous studies indicate that this procedure may adversely induce anxiety among mothers. Therefore, this study aimed to investigate anxiety among mothers whose babies received a hearing screening at a tertiary hospital in Malaysia. A cross-sectional study was conducted on 105 mothers from a tertiary hospital in Kuala Lumpur, Malaysia. Two questionnaires, the Infant Health Concern Scale (IHCS) and State-Trait Anxiety Inventory (STAI), were used to measure the mothers’ worry level on a 4-point Likert scale. Mothers were required to complete the questionnaires twice, before and 4 weeks after discharge, regardless of the hearing screening results.ResultsThe STAI scores obtained from mothers whose babies failed the initial screening were significantly higher than mothers whose babies passed. During the initial screening, all mothers rated hearing as the sixth health aspect causing anxiety using the IHCS. However, the ranking fell to 15th place after the second screening. Similarly, mothers whose babies had false positive results also exhibited significantly higher STAI scores and a dropped hearing ranking during rescreening than the initial screening. In addition, mother’s anxiety was not significantly correlated with their education level, family income, or number of births.ConclusionMothers who participated in this study experienced anxiety regardless of their babies hearing screening results. Therefore, the UNHS program must be reviewed to identify appropriate strategies to minimize this negative emotion among mothers.

Implementation of Universal Newborn Hearing Screening in the Philippines: A Survey of Registered Newborn Hearing Centers.

Universal newborn hearing screening is mandated in the Philippines through the Universal Newborn Hearing Screening and Intervention Act of 2009 (RA 9709). Newborn hearing screening (NBHS) centers are required to perform screening tests, compile and submit data on screened newborns, and advise parents on the subsequent steps after NBHS. The study aimed to conduct a survey of the implementation of the Universal Newborn Hearing Screening and Intervention Program (UNHSIP) in the different regions of the country; and assess the information technology (IT) capabilities of hearing centers. Fifty-one NBHS centers across twelve regions were surveyed through on-site inspections in 2016. Data was gathered on the centers' testing capability, staffing, access to specialists, use of local protocols, connectivity, and IT capabilities. All surveyed centers followed the recommended protocols of the Manual of Operations of the Universal Newborn Hearing Screening and Intervention Act of 2009 (RA 9709). Among the 12 regions visited, only five (41.67%) had Category C centers with confirmatory testing and early amplification services as recommended. Majority of facilities (96.1%) were staffed by trained and certified personnel. A small percentage had access to subspecialists such as clinical audiologists (39.2%) and speech-language pathologists (23.5%). All facilities had computer access, but only 58.8% had internet access. Majority (94.1%) of the centers visited were not using the recommended data submission methods, specifically the use of registry cards and the online registry. Only 27.5% of centers had data on newborns who underwent confirmatory testing or early intervention. Facilities were found to be compliant to NBHS screening protocols and majority complied with certification requirements for staff; but were found to be non-compliant with use of registry cards or the online registry. Majority of centers were able to contact the parents of neonates who did not pass newborn screening, but had no system to track outcomes. Lack of confirmatory and early intervention services in identified areas emphasize the need for development of regional centers. It is recommended that measures to improve the utilization of the online registry are taken.

Programmatic Approach to Hearing Health in Low- and Middle-Income Countries

Programmatic Approach to Hearing Health in Low- and Middle-Income Countries

International experience and recommendations on audiological screening of schoolchildren: review.

Permanent childhood hearing loss is crucial for speech development and restricts learning abilities. Universal newborn hearing screening programs are well established to detect congenital hearing loss and address the need of hearing-impaired babies. Progressive or acquired permanent hearing loss can manifest later due to genetic causes, intrauterine or postnatal infections, middle ear diseases and excessive exposure to noise when listening the personal audio devices. The hearing loss prevalence in the population of 9 year-olds three times higher compared with newborns. School hearing screening is a part of hearing across the lifespan conception. The article presents international experience and recommendations for the organization of school hearing screening programs. A school-entry hearing test is mandatory, other grades might be screened also. The basic method is pure tone audiometry at frequencies of 500, 1 000, 2 000, 4 000 Hz at 20 dB. Otoscopy and tympanometry can be performed also, while whisper voice speech test is of low sensitivity. The main hearing screening issue is low follow-up of referrals to ascertain audiological assessment. Modern approaches to the prevention of hearing loss in schoolchildren and management of hearing impairements are described. Planning of hearing screening programs requires sufficient human and logistical resources, monitoring of results and quality improvement, all stakeholders engagement.

Development of a questionnaire to assess mothers’ knowledge, attitudes and practice with regard to childhood hearing loss and Universal Newborn Hearing Screening

The assessment of the validity and reliability of measurement tools in research provides quality data. However, evidence of the validity and reliability of parental knowledge and attitude regarding childhood hearing loss and newborn hearing screening is scarce. To design a Knowledge, Attitudes and Practice (KAP) survey tool regarding childhood hearing loss and a Universal Newborn Hearing Screening Programme of the rural Amajuba district, KwaZulu-Natal, South Africa, and then test for validity and test-retest repeatability. Face validity was conducted with 20 mothers and a content validity index was determined by two rounds of assessments, the first by 7 experts and the second by 3 experts. The kappa statistic was used to measure the stability of the tool using data from 160 mothers where repeated measurements were applied at two-week intervals. The feasibility of developing a tool was assessed by applying the criteria of science, population and resources. The KAP tool was developed with twenty-nine items. For face validity, 97% of the participants reported that the items were clear, wording was appropriate and easy to read and the language was natural. Content validity produced excellent results with a scale and content validity index of 1. Test-retest repeatability for the KAP tool was good with a Cohen's kappa coefficient of 0.87 (95% CI: 0.87, 0.87). Individually, the knowledge scale had a kappa of 0.86 (95% CI: 0.77, 0.95); the attitude scale had a kappa of 0.87 (95% CI: 0.76, 0.99): the practice scale had a kappa of 0.86 (95% CI: 0.75, 0.97) and the awareness scale had a kappa of 0.92 (0.83, 1.00). The development of a KAP tool was shown to be feasible, given sufficient time, funds, motivation and a study population. The study produced a valid and reliable tool that can be useful in generating quality evidence of a community's KAP with respect to childhood hearing loss and newborn hearing screening. Evidence gathered could be used to tailor health education and health promotion material for a Universal New-born Hearing Screening (UNHS) programme in a culturally sensitive manner to promote service uptake.

A Prospective Study of Genetic Variants in Infants with Congenital Unilateral Sensorineural Hearing Loss.

Children with unilateral sensorineural hearing loss (uSNHL) have a high risk of speech-language delays and academic difficulties. Still, challenges remain in the diagnosis of uSNHL. With a prospective cross-sectional design, 20 infants were consecutively recruited from a universal newborn hearing screening program and invited to genetic testing. Eighteen of the subjects agreed to genetic testing, 15 subjects with OtoSCOPE® v.9 screening 224 genes, and four subjects underwent targeted testing, screening for chromosomal abnormalities or 105-137 gene mutations. The genetic results were described together with the 20 infants' previously published auditory profiles and imaging results. Genetic causes for the uSNHL were found in 28% of subjects (5/18) including CHARGE syndrome (CHD7), autosomal recessive non-syndromic hearing loss (GJB2), Townes-Brocks syndrome (SALL1), Pendred Syndrome (SLC26A4) and Chromosome 8P inverted duplication and deletion syndrome. In subjects with comorbidities (malformation of fingers, anus, brain, and heart), 100% were diagnosed with a genetic cause for uSNHL (3/3 subjects), while 13% (2/15 subjects) were diagnosed without comorbidities observed at birth (p = 0.002). Genetic testing for congenital uSNHL is currently efficient for alleged syndromes, whereas genetic variants for non-syndromic congenital uSNHL need further research.

Universal Newborn Hearing Screening and Incidence of Hearing Loss in Ramathibodi Hospital: A 5 Years Experience (2014 to 2018)

Background: Congenital hearing loss is an important factor affecting a child’s speech and language development. The quality of universal newborn hearing screening and hearing intervention program plays an important role in assisting children with permanent hearing to achieve appropriate speech and language development. Objectives: To assess outcomes of the revised Ramathibodi Hospital universal newborn hearing screening (RUNHS) during 2014 to 2018, and to analyze the incidence of hearing loss in infants. Methods: This study was a retrospective analysis, all newborns delivered at Ramathibodi Hospital from January 1, 2014, to December 31, 2018 were included. Data were collected from medical records and evaluated the RUNHS outcomes compared with benchmarks. Descriptive statistics were used to analyze data. Results: Of 18 597 newborns, the screening coverage rate was 99. 8%, and the referral rate was 2.5%. The follow-up rate was 92.5%, and the diagnosis rate within 3 months of age was 20.1%. Among infants diagnosed with hearing loss, 42.9% received hearing aids by 6 months of age. The incidence of congenital permanent hearing loss was between 0.5 and 1.9 per 1000 live births. Conclusions: The outcomes met the benchmarks for coverage and referral rate, but the diagnosis and hearing aid fitting rate did not meet the criteria. As of the incidence, the amount of children with congenital hearing loss in this study was similar to those reported by others.

Neonatal Hearing Screening and Prevalence of Hearing Impairment in the Time Period of COVID-19 Epidemic in the North of Iran

Background and Aim: COVID-19 is an acute respiratory disease, caused by a coronavirus named SARS-CoV-2. Previous reports suggest an association between COVID-19 infection and Hearing Loss (HL). We have investigated the Universal Newborn Hearing Screening (UNHS) results in the time period of COVID-19 epidemic in Guilan Province, north of Iran. Methods: We analyzed UNHS results from10 major obstetrics hospitals from 20th Mar 2020 to 19th Mar 2021, and compared the total UNHS positive/“refer” and total neonatal HL reports with the same time periods of recent three years. The prevalence of risk factors for HL were analyzed during the same period. Results: The total number of childbirth was decreased significantly from 27735 birth cases in Mar 2017-2018 to 18216 births in Mar 2020-2021 (p&lt;0.001), but the total “refer” rate was significantly increased from 63.0 per 1,000 births in Mar 2019-2020 to 79.8 in Mar 2020-2021 (OR=1.29, 95% CI: 1.19-1.39, p&lt;0.001), and also increased from 74.7 per 1,000 births in Mar 2017-2020 to 79.8 in Mar 2020-2021 (OR=1.07, 95% CI: 1.01-1.14, p=0.020). The HL rate increased from 10.3 per 10,000 births in Mar 2019-2020 and from 11.4 per 10,000 births in Mar 2017-2020 to 18.7 in Mar 2020-2021 (OR=1.81 and 1.63, 95% CI: 1.06-3.09 and 1.10-2.44, p=0.028 and 0.015, respectively). The prevalence of preterm birth (p=0.039) and neonatal intensive care unit stay (p=0.016) was increased significantly during Mar 2020-2021. Conclusion: The chance of “refer” results and neonatal HL, found in the UNHS program, increased during the COVID-19 epidemic in comparison to the past years. Keywords: Newborn; hearing screening; hearing loss; COVID-19

Effectiveness of universal newborn hearing screening: A systematic review and meta-analysis.

BackgroundPermanent bilateral hearing loss (PBHL) is a serious condition in newborns, with a prevalence of at least one per 1000 live births. However, there has been no recent systematic review and meta-analysis of the effectiveness of universal newborn hearing screening programs (UNHS).MethodsWe registered our study protocol on PROSPERO CRD42020175451. Primary outcomes were any identification of PBHL (ie, PBHL diagnosed at any time), age of identification of PBHL, and neurodevelopment. Two reviewers searched standard databases to March 2022 and extracted data. We used fixed and random effects meta-analysis to pool data and graded the certainty of evidence using standard methods.ResultsThe search retrieved 2834 records. We identified five studies reporting on the effects of UNHS vs no UNHS in 1 023 610 newborns. The relative risk of being identified with PBHL before nine months in infants with UNHS compared to infants without UNHS was 3.28 (95% confidence interval (95% CI) = 1.84, 5.85, one study, 1 023 497 newborns, low certainty evidence). The mean difference in the age of identification of PBHL in infants with UNHS compared to infants without UNHS was 13.2 months earlier (95% CI = -26.3, -0.01, two studies, 197 newborns, very low certainty evidence). The relative risk of infants eventually being identified with PBHL in infants with UNHS compared to infants without UNHS was 1.01 (95% CI = 0.89, 1.14, three studies, 1 023 497 newborns, low certainty evidence). At the latest follow-up at 3-8 years, the standardised mean difference (SMD) in receptive language development between infants with UNHS compared to infants without UNHS was 0.60 z scores (95% CI = 0.07, 1.13, one study, 101 children, low certainty evidence) and the mean difference in developmental quotients was 7.72 (95% CI = -0.03, 15.47, three studies, 334 children, very low certainty evidence). The SMD in expressive language development was 0.39 z scores (95% CI = -0.20, 0.97, one study, 87 children, low certainty evidence) and the mean difference in developmental quotients was 10.10 scores (95% CI = 1.47, 18.73, 3 studies, 334 children, very low certainty evidence).ConclusionsUNHS programs result in earlier identification of PBHL and may improve neurodevelopment. UNHS should be implemented across high-, middle-, and low-income countries.RegistrationPROSPERO (CRD42020175451)